Provider Demographics
NPI:1265140263
Name:COURTOUISE, JENNIFER (FNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:COURTOUISE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:GUMPENBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:383 MCPHERSON RD
Mailing Address - Street 2:
Mailing Address - City:LEASBURG
Mailing Address - State:MO
Mailing Address - Zip Code:65535-8165
Mailing Address - Country:US
Mailing Address - Phone:314-856-8053
Mailing Address - Fax:
Practice Address - Street 1:851 E 5TH ST STE 108
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-3128
Practice Address - Country:US
Practice Address - Phone:636-861-7870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014024343363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily